• Journal of Gastric Cancer
• /
• v.13 no.1
• /
• pp.19-25
• /
• 2013

Laparoscopic gastrectomy has been widely accepted especially in patients with early-stage gastric cancer. However, the safety and oncologic validity of laparoscopic gastrectomy for advanced gastric cancer are still being debated. Since the late 90s', we have been engaged in developing a stable and robust methodology of laparoscopic radical gastrectomy for advanced gastric cancer, and have established laparoscopic distinctive technique for suprapancreatic lymph node dissection, namely the outermost layer-oriented medial approach. In this article, We present the development history of this method, and current status and future perspectives of laparoscopic gastrectomy for advanced gastric cancer based on our experience and a review of the literature.

• Journal of Gastric Cancer
• /
• v.14 no.1
• /
• pp.39-46
• /
• 2014

Purpose: According to current guidelines, perioperative chemotherapy is an integral part of the treatment strategy for advanced gastric cancer. Randomized controlled studies have been conducted in order to determine whether perioperative chemotherapy leads to improved R0 resection rates, fewer recurrences, and prolonged survival. The aim of our project was to critically appraise three major studies to establish whether perioperative chemotherapy for advanced, potentially resectable gastric cancer can be recommended on the basis of their findings. Materials and Methods: We analyzed the validity of the three most important studies (MAGIC, ACCORD, and EORTC) using a standardized questionnaire. Each study was evaluated for the study design, patient selection, randomization, changes in protocol, participating clinics, preoperative staging, chemotherapy, homogeneity of subjects, surgical quality, analysis of the results, and recruitment period. Results: All three studies had serious shortcomings with respect to patient selection, homogeneity of subjects, changes in protocol, surgical quality, and analysis of the results. The protocols of the MAGIC and ACCORD-studies were changed during the study period because of insufficient recruitment, such that carcinomas of the lower esophagus and the stomach were examined collectively. In neither the MAGIC study nor the ACCORD study did patients undergo adequate lymphadenectomy, and only about half of the patients in the chemotherapy group could undergo the treatment specified in the protocol. The EORTC study had insufficient statistical power. Conclusions: We concluded that none of the three studies was sufficiently robust to justify an unrestrained recommendation for perioperative chemotherapy in cases of advanced gastric cancer.

• The Korean Journal of Nuclear Medicine
• /
• v.15 no.2
• /
• pp.1-9
• /
• 1981

Bone scans with $^{99m}Tc-MDP$ (methylene diphosphonate) were obtained and analysed in 574 patients with biopsy-proven malignancy, who visited Seoul National University Hospital from April, 1979 to June, 1931. Clinical staging was done in all patients without bone scan information and compared with bone scan to determine the predictive value of bone scanning. 1. Primary site of the maligancies were lung in 152, breast in 97, stomach in 43, colon in 15, esophagus in 9, liver and pancreas in 11, kidney in 14, bladder in 27, prostate in 22, thyroid in 20, skin in 11, bone in 9, head and neck in 36, ovary and uterus in 17, hematopoietic and lymphoretic ular system in 33, nervous system in 10, and others in 9 cases. Primary site was not defined in 39 cases. 2. Bone scans were positive in 186 cases (32.4%), which, included 48 cases (31.6%) of lung cancer, 27 cases (27.8%) of breast cancer, 12 cases(28%) of stomach cancer, 6 cases(40%) of colon cancer, 6 cases(43%) of kidney tumor, 4 cases(15%) of bladder cancer, 14 cases(64%) of prostate cancer, 3 cases(15%) of thyroid cancer and 66 other cases. 3. Bone scans were suspicious in 64 cases (11.2%) which included 29 cases (19.1%) of lung cancer, 10 cases (10.3%) of breast cancer, 4 cases (9.3%) of stomach cancer, one case (7%) of colon cancer, 3 cases(11%) of bladder cancer, 2 cases(10%) of thyroid cancer and 15 other cases. 4. Out of 121 cases with early stage of malignancy (which included 20 cases of lung cancer in stage I, II, 38 cases of breast cancer, 13 cases of stomach cancer, 8 cases of kidney tumor, 14 cases of thyroid cancer in stage $I{\sim}III$, and 6 cases of colon cancer, 14 cases of bladder cancer, 8 cases of prostate cancer in stage $A{\sim}C$, bone scans were positive in 5 cases (4.1%) which included 3 cases of lung cancer one case of breast cancer and one case of prostate cancer, and considered as further advanced stage. Out of 121 cases with early stage of malgnancy, bone scans were suspicious in 21 cases (17.4%) which inlcuded 9 cases of lung cancer, 4 cases of breast cancer, 2 cases of stomach cancer, one case of colon cancer, 3 cases of bladder cancer, and 2 cases of thyroid cancer. From these results, we concluded bone scan was useful in detecting bone metastasis in patients of early stage of malignancy, determining prognosis and establishing therapentic plan.

• Journal of Gastric Cancer
• /
• v.14 no.4
• /
• pp.275-278
• /
• 2014

Gastric cancer is rare during pregnancy, and often advanced upon presentation. A Krukenberg tumor presents a diagnostic and therapeutic challenge in the pregnant patient. We present a case of a 38-year-old woman at 22 weeks' gestation who presented with worsening epigastric pain, and was found to have a left pelvic mass on ultrasound, which was confirmed by magnetic resonance imaging. She went into active labor and delivered a viable infant via vaginal delivery. An exploratory laparotomy revealed a large mass originating from her left ovary and diffuse thickening of the lesser curvature of the stomach. Frozen section investigation revealed the presence of signet cell adenocarcinoma. Subsequent upper endoscopy showed linitis plastica, while biopsy confirmed the presence of adenocarcinoma. In conclusion, the occurrence of gastric cancer in pregnancy is rare despite extremely common symptoms. The management poses a challenge because of the need for early treatment, and the continuation of the pregnancy.

• Journal of Gastric Cancer
• /
• v.11 no.3
• /
• pp.185-188
• /
• 2011

Gastric necrosis due to gastric outlet obstruction is a very rare condition, but it might be fatal if missed or if diagnosis is delayed. Our patient was a 73-year-old male complaining of abdominal pain, distension and dyspnea for 1 day. In plain radiography and computed tomography, a markedly distended stomach and decreased enhancement at the gastric wall were noted. He underwent explo-laparotomy, and near-total gastric mucosal necrosis accompanied by sludge from the soaked laver was noted. A total gastrectomy with esophagojejunostomy was performed, and he recovered without sequelae. Final pathologic examination revealed advanced gastric cancer at the antrum with near-total gastric mucosal necrosis.

• Journal of Gastric Cancer
• /
• v.10 no.4
• /
• pp.219-225
• /
• 2010

Purpose: The long-term survival rate of gastric cancer patients after surgery has recently increased as a result of making an early diagnosis of gastric cancer. Therefore, the incidence of remnant gastric cancer is increasing. This study was performed to evaluate the clinicopathological characteristics and prognosis of patients with remnant gastric cancer. Materials and Methods: From January 2005 to December 2009, twenty-nine patients with remnant gastric cancer and who underwent surgery at Pusan National University Hospital were enrolled in this study. We retrospectively reviewed and analyzed their medical records. We also divided them into two groups: the remnant gastric cancer (RGC)-B group (first operation for benign disease) and the RGC-M group (first operation for malignant disease). Results: The RGC-B group included ten patients and the RGC-M group included nineteen patients. The mean interval between the first and second operations was 17 years. The curative resection rate was 93.1% (27/29). The postoperative complication rate was 20.7% (6/29) and there was no perioperative mortality. Ten (37%) of twenty-seven patients experienced recurrence after curative resection and eight patients (27.6%) expired due to aggravation of remnant stomach cancer. An advanced TNM stage and non-curative resection were the negative prognostic factors for survival for patients with remnant stomach cancer (P=0.0453 and P<0.001). The RGC-M group showed a shorter interval (P<0.001) and the RGC-B group had more advanced TNM stage (P=0.003). Conclusions: Long-term follow-up should be considered not only for patients who undergo an operation for malignant disease, but also for the patients who underwent an operation for benign disease. When remnant gastric cancer is diagnosed, curative resection is essential to improve the survival.

• Journal of Gastric Cancer
• /
• v.10 no.4
• /
• pp.226-233
• /
• 2010

Purpose: In resectable gastric cancer, choice regarding the extent of resection depends on tumor size, location, and distance from resection margin. However, there remains controversy for choice of resection for tumors in the middle third of the stomach. This study investigated patients who underwent gastrectomy in order to analyze the differences between total gastrectomy (TG) and subtotal gastrectomy (STG). Materials and Methods: From 2000 to 2006, 125 patients with a tumor in the middle third of the stomach underwent radical gastric resection at EUMC. We retrospectively conducted comparative analysis for the differences in clinicopathological characteristics and prognosis between TG and STG. Results: The average tumor size was 6.7 cm for TG, and 4.1 cm for STG. The number of metastatic lymph nodes were 13.3 for TG, and 3.7 for STG. Patients with more advanced cancer were more likely to receive TG. The 5-year survival rate for TG was lower (38.1%) than STG (69.0%). However, if tumor stages were stratified, there was no significant difference in the survival rate. Histologically, for the undifferentiated type of cancer (Stage 1, 2), the 5-year survival rate of STG was higher (88.1%) than TG (75.0%). Conclusions: Comparing patients with tumors in the middle third of the stomach who underwent TG and STG, there was no statistically significant difference in the 5-year survival rate. If stages were stratified, the clinicopathological characteristic becomes a key factor in deciding the prognosis, rather than the choice of resection. Thus if the radical resection margin can be obtained for a tumor in the middle third of the stomach, STG is considered instead of TG.

• Journal of Gastric Cancer
• /
• v.17 no.1
• /
• pp.93-97
• /
• 2017

An 84-year-old man was diagnosed with two synchronous adenocarcinomas, a Borrmann type IV advanced gastric adenocarcinoma in his antrum and a well-differentiated Borrmann type I carcinoma on the anterior wall of the higher body of his stomach. Pre-operatively, computed tomography of the abdomen revealed the presence of advanced gastric cancer with peri-gastric and para-aortic lymph node (LN) metastasis. He planned for palliative total gastrectomy owing to the risk of obstruction by the antral lesion. We performed a frozen biopsy of a para-aortic LN during surgery and found that the origin of the para-aortic LN metastasis was from undiagnosed prostate cancer. Thus, we performed radical total gastrectomy and D2 LN dissection. Post-operatively, his total prostate-specific antigen levels were high (227 ng/mL) and he was discharged 8 days after surgery without any complications.

• The Korean Journal of Nuclear Medicine Technology
• /
• v.14 no.2
• /
• pp.93-99
• /
• 2010

Purpose: Currently, PET/CT scan has been known to provide useful information to both preoperative and postoperative examination of cancer patients. Contracted stomach by the long fasting could cause difficulties of interpretation because of its size on reconstructed image data. To solve this problem, after the whole body PET/CT scan, patients were administrated in drinking 300 mL of water to expand stomach and performed additional scan on stomach region. Not only PET/CT scan but also CT performs this water-administration, and patients were take oral solution to make stomach expand for stomach cancer. When this scan performed, patients lay supine position. In this study, we evaluated the capacity of stomach through PET/CT scan with drinking water performed in supine and prone position so that we can distinguish exact location of cancer around pylorus and inferior wall of stomach. Furthermore, image data from supine and prone positions were analyzed the difference of volume of stomach through the change of standardized uptake values. Materials and Methods: From July 2009 to January 2010 in severance hospital, 30 patients who were diagnosed as early gastric cancer or advanced gastric cancer were chosen. All patients had PET/CT scan before the operation and have had follow-up PET/CT. The patients fast for at least 8 hours, and had an injection intravenously with $^{18}F$-FDG, 7.4 MBq (0.2 mCi/kg) per kilogram. They were rested for 60 minutes. Before the examination, all patients were administrated to drink water for 300 mL Patients had PET/CT scan with supine position around the region of stomach, whole body, and around the region of stomach with prone position after drinking another 300 mL of water respectively. Results: As a results of comparison between stomach capacity of 30 patients in supine and prone position, the study draw results that average capacity of stomach body was 460.29 $mm^2$ in supine position, and 641.39 $mm^2$ in prone position for 30 patients. The change of capacity shows 41.3% expanded in prone position. And there was no noticeable difference at maximum standardized uptake values in supine position and prone position. Conclusion: As results, stomach would have more expanded capacity in prone position than supine position. For patients who have physical disabilities to move freely, additional scan in prone position will be obstacle to perform. However, if additional scan in supine position add with the scan in prone position, it will be easier to diagnose stomach cancer. Moreover, we believe that this study will help the research for inventing support tools for patients who have physical disabilities in prone position.

• The Korean Journal of Pain
• /
• v.5 no.1
• /
• pp.113-116
• /
• 1992

The psoas compartment block has been advocated as the technique of choice for the surgical correction of the fractured neck of the femur. It is, moreover, widely used as a technique for postoperative analgesia. This block has not been discribed in the treatment of pain in cancer patients unitl 1988. A 54-year-old woman with advanced stomach cancer complained of pain in the right leg. Psoas compartment block using bupivacaine and methylprednisolone; was effective for pain control. Psoas compartment block is a useful procedure and can be of particular use in patients who have not responded to opiates or find the side effects intolerable.